Recommended immunization schedule for children age 0 through 6 years – United States, 2025 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

1vCOV-aPS: adjuvanted, protein subunit COVID-19 vaccine; 1vCOV-mRNA: monovalent mRNA COVID-19 vaccine; anti-HBs: hepatitis B surface antibody; COVID-19: coronavirus disease 2019; HBeAg: hepatitis B e antigen; HBIG: hepatitis B immune globulin; HBsAg: hepatitis B surface antigen; IIV3: trivalent inactivated influenza vaccine; LAIV3: trivalent live attenuated influenza vaccine; MenACWY-CRM: Menveo; MenACWY-TT: MenQuadfi; mIU: milli-international units; MMRV: combined measles, mumps, rubella, and varicella vaccine (ProQuad); PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PCV20: 20-valent pneumococcal conjugate vaccine; PPSV23: Pneumovax 23; RSV: respiratory syncytial virus; RV1: Rotarix; RV5: RotaTeq.

* School entry age group.

¶ Respiratory syncytial virus vaccination (RSV-mAb [nirsevimab], Beyfortus)

• Infants born October through March in most of the continental United States
  • Birthing parent did not receive RSV vaccine or birthing parent's RSV vaccination status is unknown or birthing parent received RSV vaccine during previous pregnancy: Administer 1 dose nirsevimab within 1 week of birth (ideally before discharge or in outpatient setting).
  • Birthing parent received RSV vaccine <14 days prior to delivery: Administer 1 dose nirsevimab within 1 week of birth (ideally before discharge or in outpatient setting).
  • Birthing parent received RSV vaccine at least 14 days prior to delivery: Nirsevimab not needed. Refer to UpToDate content or CDC guidance for rare circumstances when nirsevimab can be considered.
• Infants born April through September in most of the continental United States
  • Birthing parent did not receive RSV vaccine or birthing parent's RSV vaccination status is unknown or birthing parent received RSV vaccine during previous pregnancy: Administer 1 dose nirsevimab shortly before start of RSV season.
  • Birthing parent received RSV vaccine <14 days prior to delivery: Administer 1 dose nirsevimab shortly before start of RSV season.
  • Birthing parent received RSV vaccine at least 14 days prior to delivery: Nirsevimab not needed. Refer to UpToDate content or CDC guidance for rare circumstances when nirsevimab can be considered.
• Special situations:
  • Age 8 through 19 months and at risk for severe RSV disease: 1 dose nirsevimab shortly before start of 2^nd RSV season. High-risk conditions include:
    • Children with chronic lung disease of prematurity who required medical support at any time during the 6-month period before the start of the 2^nd RSV season.
    • Children who are severely immunocompromised.
    • Children with cystic fibrosis who have manifestations of severe lung disease or have weight-for-length that is <10^th percentile.
    • American Indian and Alaska Native children.
  • Age-eligible and undergoing cardiac surgery with cardiopulmonary bypass: 1 additional dose of nirsevimab after surgery. For additional details, refer to special populations and situations at https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/infants-young-children.html.

Infants with prolonged birth hospitalization (eg, for prematurity) discharged October through March should be immunized shortly before or promptly after discharge.

Refer to UpToDate content for additional details.

Δ Hepatitis B (HepB) vaccination

• Routine vaccination (birthing parent is HBsAg-negative):
  • 3-dose series at age 0, 1 through 2, and 6 through 18 months (use monovalent HepB vaccine for doses administered before age 6 weeks).
    • Birth weight ≥2 kg: 1 dose within 24 hours of birth if medically stable.
    • Birth weight <2 kg: 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2 kg).
  • Infants who did not receive a birth dose should begin the series as soon as possible. Refer to UpToDate content related to the catch-up immunization schedule.
  • Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
  • Final (3^rd or 4^th) dose: Age 6 through 18 months (minimum age 24 weeks).
• Birthing parent is HBsAg-positive:
  • Birth dose (monovalent HepB vaccine only): Administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth, regardless of birth weight.
  • Birth weight <2 kg: Administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses).
  • Final (3^rd or 4^th dose): Administer at age 6 months (minimum age 24 weeks).
  • Test for HBsAg and anti-HBs at age 9 through 12 months. If HepB series is delayed, test 1 to 2 months after final dose. Do not test before age 9 months.
• Birthing parent is HBsAg-unknown: If other evidence suggestive of existing birthing parent hepatitis B infection (eg, presence of HBV DNA, HBeAg-positive, or birthing parent known to have chronic hepatitis B infection), manage infant as if birthing parent is HBsAg-positive.
  • Birth dose (monovalent HepB vaccine only):
    • Birth weight ≥2 kg: Administer HepB vaccine within 12 hours of birth. Determine birthing parent's HBsAg status as soon as possible. If birthing parent is determined to be HBsAg-positive, administer HBIG as soon as possible (in separate limb) but no later than 7 days of age.
    • Birth weight <2 kg: Administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth. Administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses).
  • Final (3^rd or 4^th) dose: Administer at age 6 months (minimum age 24 weeks).
  • If birthing parent is determined to be HBsAg-positive or if status remains unknown, test for HBsAg and anti-HBs at age 9 through 12 months. If HepB series is delayed, test 1 to 2 months after final dose. Do not test before age 9 months.
• Special situations:
  • Revaccination is generally not recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
  • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
    • Infants born to HBsAg-positive birthing parents.
    • Persons who are predialysis or on maintenance dialysis.
    • Other immunocompromised persons.
  • For detailed revaccination recommendations, refer to https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm.

◊ Rotavirus (RV) vaccination

• RV1 (Rotarix): 2-dose series at age 2 and 4 months.
• RV5 (RotaTeq): 3-dose series at age 2, 4, and 6 months.
• If any dose in the series is either RV5 or unknown, default to 3-dose series.

§ Diphtheria and tetanus toxoids, and acellular pertussis (DTaP) vaccination

• Routine: 5-dose series (3-dose primary series at age 2, 4, and 6 months, followed by booster doses at 15 through 18 months and 4 through 6 years).
• Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
• Retrospectively: A 4^th dose that was inadvertently administered as early as 12 months may be counted if at least 4 months have elapsed since dose 3.
• Children younger than age 7 years with a contraindication specific to the pertussis component of DTaP: May administer Td for all recommended remaining doses in place of DTaP. Encephalopathy within 7 days of vaccination when not attributable to another identifiable cause is the only contraindication specific to the pertussis component of DTaP. For additional information, refer to http://www.cdc.gov/pertussis/hcp/vaccine-recommendations/td-offlabel.html.
• Wound management: Refer to www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm for DTaP vaccination indications as part of wound management.

¥ Haemophilus influenzae type b (Hib) vaccination

• Routine vaccination:
  • ActHIB, Hiberix, Pentacel, or Vaxelis: 4-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose at age 12 through 15 months). Vaxelis is not recommended for use as a booster dose. A different Hib-containing vaccine should be used for the booster dose.
  • PedvaxHIB: 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12 through 15 months).
  • American Indian and Alaska Native infants: Vaxelis and PedvaxHIB preferred over other Hib vaccines for the primary series.
• Special situations:
  • Refer to UpToDate content related to Hib vaccination and immunization in the specific high-risk group and the ACIP recommendations. Special situations and high-risk groups include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early complement component deficiency.

‡ Pneumococcal vaccination

• Routine vaccination with PCV:
  • 4-dose series at age 2, 4, 6, and 12 through 15 months.
• NOTE: PCV15 and PCV20 can be used interchangeably for children who are healthy or have underlying conditions. If the infant received PCV13 for the initial doses, the series may be completed with PCV15 or PCV20; restarting the series is not necessary.
• Special situations:
  • High-risk conditions: Refer to separate UpToDate content and the ACIP recommendations for information on pneumococcal vaccination in children with high-risk conditions.
  • High-risk conditions include cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome, which are included in immunocompromising conditions); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; diabetes mellitus; immunocompromising conditions (on maintenance dialysis or with nephrotic syndrome; congenital or acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases and conditions treated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and solid organ transplant; HIV infection; and sickle cell disease or other hemoglobinopathies).

† Inactivated poliovirus (IPV) vaccination

• 4-dose series at age 2, 4, and 6 through 18 months, and 4 through 6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
• 4 or more doses of IPV can be administered before age 4 years when a combination vaccine containing IPV is used. However, a dose is still recommended at or after age 4 years and at least 6 months after the previous dose.

** COVID-19 vaccination

(Minimum age: 6 months [1vCOV-mRNA (Pfizer-BioNTech and Moderna vaccines)])

All vaccine doses should be from the same manufacturer for all children age 6 months through 4 years.

All vaccine doses of the primary series should be from the same manufacturer for immunocompromised children age 5 and 6 years.

• Age 6 months through 4 years:
  • Unvaccinated: 2-dose series of updated (2024-2025 formula) Moderna at 0, 4 through 8 weeks or 3-dose series of updated (2024-2025 formula) Pfizer-BioNTech at 0, 3 through 8 weeks and at least 8 weeks after dose 2.
  • Previously vaccinated with:
    • 1 dose of Moderna: 1 dose of updated (2024-2025 formula) Moderna 4 to 8 weeks after most recent dose.
    • 2 or more doses of Moderna: 1 dose of updated (2024-2025 formula) Moderna at least 8 weeks after most recent dose.
    • 1 dose of Pfizer-BioNTech: 2-dose series of updated (2024-2025 formula) Pfizer-BioNTech at 0 and 8 weeks (minimum interval between previous dose and dose 1: 3 through 8 weeks).
    • 2 or more doses of Pfizer-BioNTech: 1 dose of updated (2024-2025 formula) Pfizer-BioNTech at least 8 weeks after most recent dose.
• Age 5 through 6 years:
  • Unvaccinated: 1 dose of updated (2024-2025 formula) Moderna or Pfizer-BioNTech vaccine.
  • Previously vaccinated with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2024-2025 formula) Moderna or Pfizer-BioNTech at least 8 weeks after most recent dose.
• Moderately or severely immunocompromised:
  • Unvaccinated:
    • Age 6 months through 4 years: 4 doses (initial 3-dose series at 0, 4 weeks, and at least 4 weeks of updated (2024-2025 formula) Moderna, followed by 1 dose of Moderna 6 months later (minimum interval 2 months) or 4 doses (initial 3-dose series at 0, 3 weeks, and at least 8 weeks after dose 2) of updated (2024-2025 formula) Pfizer-BioNTech, followed by 1 dose of Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • Age 5 through 6 years: 4 doses (initial 3-dose series at 0, 4 weeks, and at least 4 weeks after dose 2) of updated (2024-2025 formula) Moderna, followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months) or 4 doses (initial 3-dose series at 0, 3 weeks, and at least 4 weeks after dose 2) of updated (2024-2025 formula) Pfizer-BioNTech, followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
  • Ages 6 months through 4 years and previously vaccinated with:
    • 1 dose of Moderna: Complete initial series with 2 doses of updated (2024-2025 formula) Moderna at least 4 weeks apart (minimum interval between previous dose and dose 1: 4 weeks), followed by 1 dose of Moderna 6 month later (minimum interval 2 months).
    • 2 doses of Moderna: Complete initial series with 1 dose of updated (2024-2025 formula) Moderna at least 4 weeks after most recent dose, followed by 1 dose of Moderna 6 months later (minimum interval 2 months).
    • 3 or more doses of Moderna before 2024-2025 vaccine available: 2 doses of updated (2024-2025 formula) Moderna at least 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after most recent dose.
    • 1 dose of Pfizer-BioNTech: Complete initial series with 2 doses of updated (2024-2025 formula) Pfizer-BioNTech at least 8 weeks apart (minimum interval between previous dose and dose 1: 3 weeks), followed by 1 dose of Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 2 doses of Pfizer-BioNTech: Complete initial series with 1 dose of updated (2024-2025 formula) Pfizer-BioNTech at least 8 weeks after the most recent dose, followed by 1 dose of Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 3 or more doses of Pfizer-BioNTech before 2024-2025 vaccine available: 2 doses of updated (2024-2025 formula) Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose.
  • Ages 5 through 6 years and previously vaccinated with:
    • 1 dose of Moderna: Complete initial series with 2 doses of updated (2024-2025 formula) Moderna at least 4 weeks apart (minimum interval between previous dose and dose 1: 4 weeks), followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 2 doses of Moderna: Complete initial series with 1 dose of updated (2024-2025 formula) Moderna at least 4 weeks after most recent dose, followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 1 dose of Pfizer-BioNTech: Complete initial series with 2 doses of updated (2024-2025 formula) Pfizer-BioNTech at least 4 weeks apart (minimum interval between previous dose and dose 1: 3 weeks), followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 2 doses of Pfizer-BioNTech: Complete initial series with 1 dose of updated (2024-2025 formula) Pfizer-BioNTech at least 4 weeks after the most recent dose, followed by 1 dose of Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 3 or more doses of Moderna or Pfizer-BioNTech before 2024-2025 vaccine available: 2 doses of updated (2024-2025 formula) Moderna or Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose.
• NOTE: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, refer to www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

¶¶ Influenza vaccination

• Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content related to influenza vaccination in children and the ACIP recommendations):
  • 2 doses separated by at least 4 weeks for children age 6 months through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2024, or whose influenza vaccination history is unknown.
  • 1 dose for children age 6 months through 8 years who have received at least 2 influenza vaccine doses before July 1, 2024.
• For the 2024-2025 season, refer to https://www.cdc.gov/mmwr/volumes/73/rr/rr7305a1.htm.
• For the 2025-2026 season, refer to the 2025-2026 ACIP influenza vaccine recommendations.

ΔΔ Measles, mumps, and rubella (MMR) vaccination

• Routine vaccination:
  • 2-dose series at age 12 through 15 months and age 4 through 6 years.
  • MMR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
• International travel:
  • Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2-dose series at age 12 through 15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.
  • Unvaccinated children age 12 months or older: 2 doses at least 4 weeks apart before departure.
  • Previously received 1 dose and age 12 months or older: Administer dose 2 at least 4 weeks after dose 1.

◊◊ Varicella (VAR) vaccination

• 2-dose series at 12 through 15 months and 4 through 6 years.
• VAR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
• Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after a 4-week interval may be counted as valid).

§§ Hepatitis A (HepA) vaccination

• Routine vaccination:
  • 2-dose series (minimum interval: 6 months) at age 12 through 23 months.
• International travel:
  • Persons traveling to countries with high or intermediate endemic hepatitis A (refer to www.cdc.gov/travel):
    • Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between age 12 and 23 months.
    • Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

¥¥ Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

• Special situations:
  • Refer to UpToDate content related to meningococcal vaccines and immunization in specific high-risk groups. High-risk groups include anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, and travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to www.cdc.gov/travel).
  • MenACWY-CRM (Menveo) has 2 formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.